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Carrandi A, Bull C, Hu Y, Grzeskowiak LE, Teede H, Black K, Callander E. Patterns in the provision of government-subsidised hormonal postpartum contraception in Queensland, Australia between 2012 and 2018: a population-based cohort study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:13-20. [PMID: 37353310 DOI: 10.1136/bmjsrh-2023-201830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Short birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country. METHODS We used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals. RESULTS A majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger (<25 years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts. CONCLUSIONS Strategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women's fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women's access to contraceptive services and, further, the types of contraception provided.
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Affiliation(s)
- Alayna Carrandi
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Claudia Bull
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Yanan Hu
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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McFarland KV, Hefelfinger LM, Mendez CV, DeFranco EA, Kelly E. Social determinants among Black people during pregnancy following a short interpregnancy interval. AJOG GLOBAL REPORTS 2023; 3:100279. [PMID: 38034023 PMCID: PMC10684387 DOI: 10.1016/j.xagr.2023.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Short interpregnancy interval has been shown to be a key contributor to infant mortality. Black pregnant people have a higher incidence of short interpregnancy interval than people of other races and ethnicities, as well as higher rates of infant mortality. Understanding the factors related to racial disparities in short interpregnancy interval and infant mortality are a public health priority. OBJECTIVE This study aimed to examine the relationship between social determinants of health and interpregnancy interval in Black pregnant people by comparing those with a short interpregnancy interval defined as <18 months with those with a referent interpregnancy interval defined as ≥18 months. STUDY DESIGN This was a nested case-control study from a prospective cohort analyzing social determinants of health in 576 postpartum patients at an urban medical center, 2011-2021. Sociodemographic, pregnancy, and maternal characteristic data were collected from participants' medical records. Structured interviews measured participants' health behaviors, physical environment, social support, health literacy, and structural drivers. Differences in social determinants of health among Black study participants were compared between those with a short interpregnancy interval (<18 months) and those with a referent interpregnancy interval (≥18 months). The odds ratios were calculated to assess the association between short interpregnancy interval and social determinants. Factors with significant differences between the short interpregnancy interval and referent interpregnancy interval groups in Black participants were compared with that of White groups for social context. RESULTS Black participants with a short interpregnancy interval were more likely to report financial support from the Special Supplemental Nutrition Program for Women, Infants, and Children (odds ratio, 2.4; 95% confidence interval, 1.2-5.1), negative feelings toward the pregnancy (odds ratio, 2.4; 95% confidence interval, 1.2-4.9), choosing not to breastfeed because they do not like it (odds ratio ,12.0; 95% confidence interval, 1.5-543.1), not receiving prenatal care as early as desired (odds ratio, 3.4; 95% confidence interval, 1.6-7.2) because of consid- eration of pregnancy termination (odds ratio, 5.2; 95% confidence interval, 1.2-30.5) and less likely to report low levels of social support (odds ratio, 0.3; 95% confidence interval, 0.1-0.8) than Black participants with a referent interpregnancy interval. CONCLUSION Social determinants of health that differed between participants with a short interpregnancy interval and those with a referent interpregnancy interval were Special Supplemental Nutrition Program for Women, Infants, and Children support, feelings toward the pregnancy, social support, breastfeeding intent, and delayed prenatal care because of consideration of abortion. Previous studies examining infant mortality risk factors used White people as the referent group when analyzing social determinants. Our study focused specifically on understanding the lives of Black pregnant people so that future public health initiatives focused on social determinants may attenuate the racial disparity of infant mortality in the United States.
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Affiliation(s)
- Katy V. McFarland
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, (Mses McFarland, Hefelfinger, and Mendez and Drs DeFranco and Kelly) Cincinnati, OH
| | - Leah M. Hefelfinger
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, (Mses McFarland, Hefelfinger, and Mendez and Drs DeFranco and Kelly) Cincinnati, OH
| | - Christina V. Mendez
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, (Mses McFarland, Hefelfinger, and Mendez and Drs DeFranco and Kelly) Cincinnati, OH
| | - Emily A. DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, (Mses McFarland, Hefelfinger, and Mendez and Drs DeFranco and Kelly) Cincinnati, OH
| | - Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, (Mses McFarland, Hefelfinger, and Mendez and Drs DeFranco and Kelly) Cincinnati, OH
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, (Dr Kelly) Cincinnati, OH
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Zimmerman LA, Karp C, Magalona S, Shiferaw S, Seme A, Ahmed S. Exploring Multiple Measures of Pregnancy Preferences and Their Relationship with Postpartum Contraceptive Uptake Using Longitudinal Data from PMA Ethiopia. Stud Fam Plann 2023; 54:467-486. [PMID: 37589248 DOI: 10.1111/sifp.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
There are significant gaps in our understanding of how the experience of an unintended pregnancy affects subsequent contraceptive behavior. Our objective was to explore how three measures of pregnancy preferences-measuring timing-based intentions, emotional orientation, and planning status-were related to the uptake of postpartum family planning within one year after birth. Additionally, we tested whether the relationship between each measure and postpartum family planning uptake differs by parity, a key determinant of fertility preference. Adjusted hazards regression results show that the timing-based measure, specifically having a mistimed pregnancy, and the emotional response measure, specifically being unhappy, were associated with contraceptive uptake in the extended postpartum period, while those related to pregnancy planning, as measured by an adapted London Measure of Unplanned Pregnancy, were not. This effect differed by parity; high parity women were consistently the least likely to use contraception in the postpartum period, but the effect of experiencing an unwanted pregnancy or having a mixed reaction to a pregnancy was significantly stronger among high parity compared to low parity women. Greater attention to the entirety of women's responses to unanticipated pregnancies is needed to fully understand the influence of unintended pregnancy on health behaviors and outcomes for women and their children.
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Vulnerabilidade a vivenciar uma gravidez não intencional entre mulheres usuárias do Sistema Único de Saúde. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao0310345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kusunoki Y, Barber JS. The Dynamics of Intimate Relationships and Contraceptive Use During Early Emerging Adulthood. Demography 2021; 57:2003-2034. [PMID: 32901407 DOI: 10.1007/s13524-020-00916-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigate the immediate social context of contraceptive behaviors: specifically, the intimate relationship. We use the Relationship Dynamics and Social Life (RDSL) study (2008-2012), based on a random sample of 1,003 women ages 18-19 residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18-22. We test three sets of hypotheses about change over time within a relationship, using relationship-level within-between models, which compare a couple's contraceptive behaviors across different times in the relationship. First, we find that a couple is less likely to use contraception when the relationship is more intimate and/or committed and that a couple becomes less likely to use contraception over time, regardless of intimacy and commitment. Second, we find that a couple using contraception becomes increasingly likely to choose hormonal over coital methods, but this change occurs as a relationship endures and is unrelated to intimacy and/or commitment. Third, we find that a condom-using couple's consistency does not decline when there is conflict; rather, consistency of condom use declines over time regardless of the relationship's characteristics. We also demonstrate that conflict and power imbalance increase reliance on hormonal methods among those using contraception; conflict decreases consistency among withdrawal (but not condom) users; and nonmonogamy increases reliance on condoms and decreases withdrawal consistency. The strong and consistent link between duration and contraceptive behaviors-regardless of intimacy, commitment, conflict, or power imbalance-suggests that the continual vigilance required for long-term contraceptive use is difficult during early emerging adulthood.
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Affiliation(s)
- Yasamin Kusunoki
- School of Nursing, Department of Systems, Populations and Leadership, and Population Studies Center and Survey Research Center at the Institute for Social Research, University of Michigan, 400 North Ingalls Street, Room 4156, Ann Arbor, MI, 48109-4582, USA.
| | - Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, 47405-7103, USA
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Can LARC Fulfill Its Potential to Reduce U.S. Women’s Unintended Pregnancy Risk? Examining Women’s Contraception and Childbearing in the Year Before Initiating LARC. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Are Births More Likely to be Intended Following Use of Long-Acting Reversible Contraceptives? An Analysis of U.S. Births in 2003–2015. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Steenland MW, Pace LE, Sinaiko AD, Cohen JL. Medicaid Payments For Immediate Postpartum Long-Acting Reversible Contraception: Evidence From South Carolina. Health Aff (Millwood) 2021; 40:334-342. [PMID: 33523747 DOI: 10.1377/hlthaff.2020.00254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2012 South Carolina's Medicaid program was the first state Medicaid program to separate payment for the immediate postpartum placement of long-acting reversible contraception (intrauterine devices and contraceptive implants) from its global maternity payment. Examining data on all Medicaid-insured South Carolina women giving birth from 2010 to 2014, we found that the new policy achieved its explicit goal: increasing the availability of immediate postpartum long-acting reversible contraception. Among adolescents, for whom most pregnancies are unintended, this represented new use of long-acting reversible options, rather than substitution for sterilization or for short-acting reversible methods. Therefore, the new policy also significantly increased use of highly effective postpartum contraception in an age group that is particularly vulnerable to closely spaced, higher-risk repeat pregnancies. However, fewer than half of facilities began to offer immediate postpartum long-acting reversible contraceptives after the policy change. Additional policy approaches may be needed to achieve widespread availability of this option.
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Affiliation(s)
- Maria W Steenland
- Maria W. Steenland is an assistant professor of population studies in the Population Studies and Training Center at Brown University, in Providence, Rhode Island
| | - Lydia E Pace
- Lydia E. Pace is an assistant professor in the Division of Women's Health, Brigham and Women's Hospital, and an assistant professor in medicine at Harvard Medical School, in Boston, Massachusetts
| | - Anna D Sinaiko
- Anna D. Sinaiko is an assistant professor of health economics and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Jessica L Cohen
- Jessica L. Cohen is the Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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The social context of retrospective-prospective changes in pregnancy desire during the transition to adulthood: The role of fathers and intimate relationships. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Shreffler KM, Tiemeyer S, Price JR, Frye LT. The role of pregnancy intendedness and prenatal contraceptive counseling on postpartum contraceptive use. Contracept Reprod Med 2020; 5:28. [PMID: 33101704 PMCID: PMC7579982 DOI: 10.1186/s40834-020-00127-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval). Methods Logistic regression models were used to examine risk for no postpartum contraception use among a sample of low-income and racially/ethnically diverse women recruited from two metropolitan perinatal clinics in Tulsa, OK. Results Women who reported that they were trying to get pregnant or “okay either way” about getting pregnant had significantly lower odds of using contraception at 6 months post childbirth than those who had unintended pregnancies. Having providers who discussed postpartum contraceptive options during pregnancy significantly increased the odds of contraceptive uptake among those who were planning or ambivalent about their pregnancies. Conclusions Intentions of a current pregnancy and provider contraceptive counseling matter for postpartum contraceptive use and the associated risk for a short interval subsequent pregnancy. Provider contraceptive counseling that accounts for the intendedness of a current pregnancy may offer a more targeted approach to prevent a short interval subsequent pregnancy.
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Affiliation(s)
| | - Stacy Tiemeyer
- Oklahoma State University, 700 N. Greenwood Ave, Tulsa, OK 74106 USA
| | - Jameca R Price
- University of Oklahoma Health Sciences Center, 4502 E. 41st St, Tulsa, OK 74135 USA
| | - Lance T Frye
- Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107 USA
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Rendall MS, Harrison EY, Caudillo ML. Intentionally or Ambivalently Risking a Short Interpregnancy Interval: Reproductive-Readiness Factors in Women's Postpartum Non-Use of Contraception. Demography 2020; 57:821-841. [PMID: 32096094 PMCID: PMC8493517 DOI: 10.1007/s13524-020-00859-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A focus of research on short interpregnancy intervals (IPI) has been on young disadvantaged women whose births are likely to be unintended. Later initiation of family formation in the United States and other high-income countries points to the need to also consider a woman's attributes indicative of readiness for purposefully accelerated family formation achieved through short IPIs. We test for whether factors indicating "reproductive readiness"-including being married, being older, and having just had a first birth or a birth later than desired-predict a woman's non-use of contraception in the postpartum months. We also test for whether this contraceptive non-use results explicitly from wanting to become pregnant again. The data come from the 2012-2015 Pregnancy Risk Assessment Monitoring System, representing women who recently gave birth in any of 35 U.S. states and New York City (N = 120,111). We find that these reproductive-readiness factors are highly predictive of women's postpartum non-use of contraception because of a stated desire to become pregnant and are moderately predictive of contraceptive non-use without an explicit pregnancy intention. We conclude that planning for, or ambivalently risking, a short IPI is a frequent family-formation strategy for women whose family formation has been delayed. This is likely to become increasingly common as family formation in the United States is initiated later in the reproductive life course.
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Affiliation(s)
- Michael S Rendall
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, 20742, USA.
| | | | - Mónica L Caudillo
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, 20742, USA
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